1428 What influences decisions and predicts transfer of older care-home residents to the emergency department? A synthesis of qualitative reviews and systematic review

Aims, Objectives and BackgroundThe proportion of adults aged over 65 is rapidly increasing in developed countries. Care home residents have disproportionate rates of transfer to the ED. An estimated 40% of emergency admissions for care home residents may be for avoidable conditions and up to 8-fold variation in hospitalisations has been identified between care homesWe aimed to synthesise the qualitative research collated in existing reviews relating to the experience of residents, family members and professionals in decisions to transfer care home residents to the ED and identify known factors which predict ED transfer from care homes.Method and DesignTwo systematic reviews were conducted simultaneously. The first identified and synthesised the qualitative evidence presented in existing systematic reviews regarding decisions to transfer residents to the ED. The second identified quantitative factors found to affect likelihood of transfer of residents. Five electronic databases were searched, including: MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus.Results and ConclusionIn the qualitative component, six previous reviews met the inclusion criteria. Three syntheses were formed : (i) Transfer decisions involve negotiation with unequal power dynamics between residents, family members, care home staff and clinical practitioners (ii) Some transfers occur with the expectation that treatment in hospital will improve outcomes (iii) Some transfers occur due to factors external to the resident with no expectation that hospitalisation will be beneficial.Twenty-six primary studies met the inclusion criteria for the quantitative component. Seven common domains of factors associated with ED transfer were identified: demographics, co-morbidities, medication use, frailty, permanent indwelling devices, advanced directives and care home organisation. Within these domains, male sex, age, presence of specific comorbidities, polypharmacy and quality rating were associated with ED transfer across studies.This provides context for policy makers and researchers „developing interventions to reduce hospitalisations or use adjusted rates of hospitalisations as a care home quality indicator.